Nutritional Support in Acute Severe Pancreatitis- Nasojejunal vs. Nasogastric Feed

Abstract

BACKGROUND Nutritional support is an important aspect in the management of acute pancreatitis. Enteral feeding can be given either through nasogastric or nasojejunal route. Studies have shown that nasojejunal tube placement is cumbersome and that nasogastric feeding is an effective means of providing enteral nutrition. However, the concern that nasogastric feeding increases the chance of aspiration and exacerbates acute pancreatitis by stimulating pancreatic secretion has prevented it as the standard of care.The primary objective of this study was to compare nasogastric feeding and nasojejunal feeding routes of enteral nutrition in acute severe pancreatitis with regards to safety and effectiveness. MATERIALS AND METHODSThis is a Prospective Descriptive study. This study was done to compare nasogastric vs. nasojejunal feeding in acute severe pancreatitis. The total number of patients in the study were sixty, (n= 60). Thirty patients were in nasogastric feeding group, while thirty patients were in the nasojejunal group (NG group= 30; NJ group= 30). CONCLUSIONThe nasogastric route of enteral nutrition appears to be an effective route of enteral nutrition in predicted severe acute pancreatitis. Nasogastric feeding is safe and well tolerated, and is simple and easy to establish. The nasogastric route of enteral nutrition appears too comparable to the nasojejunal route in terms of safety, tolerance and efficacy. So both the routes can be used for enteral nutrition in acute severe pancreatitis. RESULTSSerum albumin as measured in biochemical tests was also similar. Serum albumin was measured in all patients at the end of one week and then at the end of 7 weeks after receiving enteral nutrition. Serum albumin had decreased from the baseline. However, the decrease was comparable in both NG and NJ groups and there was no statistically significant difference in both the groups.

Impact of nutritional support routes on mortality in acute pancreatitis: A network meta‐analysis of randomized controlled trials

“…Following automated and manual de‐duplication processes ( i = 342), screening for irrelevant titles or abstracts ( i = 745), and thorough review of full‐texts ( i = 68), 30 records were deemed eligible based on predefined criteria. These 30 references corresponded to reports emanating from 27 RCTs [17, 19–21, 23, 24, 22, 32–54]. It is noteworthy that all identified RCTs were subsequently incorporated into the synthesis, as depicted in Fig.…”

“…Within the RCTs, diverse treatment modalities were administered, including NPO to 244 patients, TPN to 450 patients, NJ feeding to 590 patients, NG feeding to 209 patients, and oral feeding to 101 patients. Notably, 18 trials specifically addressed SAP [17, 19–21, 23, 24, 22, 32–34, 36, 38, 44, 45, 47, 48, 50, 52], 6 RCTs focused on non‐severe pancreatitis [41, 42, 46, 49, 51, 53], whereas the severity classification remained unspecified in the remaining three trials [35, 40, 54]. Initiating nutritional support within 24 h was practiced in 10 of the 27 RCTs, whereas 6 studies commenced nutritional intervention within 48 h. Additionally, nine trials did not restricte initiation of nutritional support within 48 h, and two did not specify the exact timing of nutritional intervention.…”

“…However, the differentiation between NG and NJ feeding and the definite time for using NG or NJ after admission still remain imprecise. First, it is worth noting that six published RCTs have directly compared NG and NJ feeding in severe acute pancreatitis (SAP) [19–24]. However, only four RCTs have been included in the recent three meta‐analyses that compared NG and NJ feeding, and pooled results do not show significant finding [5, 12, 19–21, 24, 25].…”

“…However, only four RCTs have been included in the recent three meta‐analyses that compared NG and NJ feeding, and pooled results do not show significant finding [5, 12, 19–21, 24, 25]. Additionally, to reach a more conclusive statement on the efficacy of NG and NJ feeding, the evidence from two additional RCTs conducted in 2015 and 2018 should also be taken into consideration [22, 23]. Second, the ESPEN guideline in 2020 suggests that although the evidence is not strong, early enteral feeding should be given within 24 to 72 h in AP patients who were intolerant to oral feeding [4].…”